WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region : development and mixed-methods validation in six countries

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers' perspective. DESIGN: Mixed-methods study. SETTING: Six countries of the WHO European Region. PARTICIPANTS AND METHODS: The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries. RESULTS: The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach's alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet's AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording. CONCLUSIONS: Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire's use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC. TRAIL REGISTRATION NUMBER: NCT04847336.publishersversionPeer reviewe

Womenʼs perspectives on the quality of maternal and newborn care in childbirth during the COVID-19 pandemic in Latvia: Results from the IMAgiNE EURO study on 40 WHO standards-based quality measures

Objective To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. Methods Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards-based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. Results 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001). Conclusion This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required.publishersversionPeer reviewe

Knowledge of medical students about reproduction and current issues of family planning in Latvia

MedicīnaVeselības aprūpeMedicineHealth CareIevads: Iedzīvotāju skaits Latvijā pēdējo 10 gadu laikā ir samazinājies par 200 tūkstošiem. Mātes vecums ir pieaudzis no 23 gadiem 1995. gadā līdz 28 gadiem 2018. gadā, kā rezultātā ģimenes plānošana var tikt atlikta līdz brīdim, kad sievietes reproduktīvā funkcija ir fizioloģiski samazināta vecuma dēļ. Mērķis: Noskaidrot medicīnas studentu zināšanas un uzskatus par reproduktīvo funkciju, to fizioloģiskām izmaiņām dzīves laikā, neauglības ārstēšanas metodēm. Izzināt ģimenes plānošanas aktualitātes medicīnas studentu vidū Latvijā. Materiāli un metodes: Pētījumā tika aptaujāti RSU un LU medicīnas fakultāšu studenti no 1. – 6. kursam. Anketēšana norisinājās no 2019. gada novembra līdz 2020. gada februārim. Anketēšanai tika izmantota anonīma anketa. Tās aprobēšanā piedalījās 5 studenti. Respondentu aptaujāšana notika elektroniskā veidā Google Forms tiešsaistes sociālajos tīklos un e-pastos. Aptaujas izveidošanai tika izmantoti 3 ārzemju pētījumi. Tā sastāvēja no 3 daļām – demogrāfiskie dati, ģimenes plānošana, zināšanas par auglību. Rezultātu apkopošanai un statistiskai datu apstrādei tika izmantotas programmas Microsoft Excel 2010 un IBM SPSS Statistics, 23. Datu analīzē tika izmantoti Chi Square un Mann-Whitney U testi. Rezultāti: Pētījumā piedalījās 291 medicīnas students vecumā no 18 – 37 g. v., ar vidējo vecumu 23,03 g. v. (SD 3,27). 92 % (N=275) studentu savā dzīvē plāno bērnus. 42,6 %. (N=124) jauniešu vēlas 2 – 3 bērnus, 26 % (N=76) vēlas 1 – 2 bērnus. Savu pirmo bērnu lielākā daļa jauniešu vēlētos 25 – 29 gadu vecumā (N=189, 64,9%) un savu pēdējo bērnu 30 – 34 gadu vecumā (N=134, 46%). Starp visiem respondentiem 246 (84,5%) ir ļoti svarīgas stabilas partnerattiecības, 234 (80,4%), ka ir partneris, ar kuru dalīt atbildību, 188 studentiem (64,6%), ka ir patstāvīgs darbs pirms kļūt par vecākiem. 5. un 6. studiju gada studenti parādīja labākas zināšanas jautājumos par menstruālā cikla fāzi, kad ir vislielākā iespējamība iestāties grūtniecībai (N=95, 92,2%) (p=0,042), ka pārim būtu jāvēršas pēc speciālista palīdzības pēc 12 mēnešiem regulāri nodarbojoties ar dzimumdzīvi, bez kontracepcijas neiestājoties grūtniecībai, ja sieviete ir jaunāka par 35 gadiem (N=79, 76,7%) (p=0,000), kā arī par auglību ietekmējošiem faktoriem – orālās kontracepcijas lietošanu, gonoreju vai hlamīdiju infekciju, aptaukošanos. Secinājumi: Sievietēm ir statistiski svarīgāk radīt bērnus nekā vīriešiem. Tāpat sievietes vairāk uzskata, ka kļūstot par mātēm viņas sniegtu un saņemtu vairāk mīlestības, rodas jaunas intereses dzīvē un veidojas cits viedoklis par to, kas ir svarīgs. Studentiem ir salīdzinoši labas zināšanas par sievietes auglību negatīvi ietekmējošiem dzīvesveida faktoriem, kā smēķēšana, nepietiekams svars, gonorejas vai hlamīdijas infekcija, aptaukošanās.Background: During last 10 years the population in Latvia has decreased by 200 thousand inhabitants. The maternal age has grown from 23 years of age in 1995 till 28 years of age in 2018. Postponing the childbirth can lead to the age-related fertility decline. Aim of the study: To find out medical students' knowledge and beliefs about female’s reproductive function, it’s physiological changes during life, methods of treatment of infertility. To find out the topicalities of family planning among medical students in Latvia. Material and methods: Students of RSU and LU Faculty of Medicine from 1st to 6th year were surveyed in the study. The questionnaire was carried out between November 2019 and February 2020. An anonymous questionnaire was used for the questionnaire. Five students participated in its approbation. Respondents were surveyed electronically via Google Forms online social networks and emails. 3 foreign studies were used for the survey. It consisted of 3 parts - demographics, family planning, knowledge about fertility. Microsoft Excel 2010 and IBM SPSS 23 Statistics were used for data collection and statistical processing. Chi Square and Mann-Whitney U tests were used for data analysis. Results: 291 medical students aged 18 – 37 participated in the study, with an average age of 23.03. (SD 3.27). 92% (N=275) of students plan to have children in their lives. 42.6% (N=124) of young people want 2 to 3 children, 26% (N=76) want 1 to 2 children. Most young people would like to have their first child between the ages of 25 and 29 (N = 189, 64.9%) and their last child between the ages of 30 and 34 (N = 134, 46%). Of all respondents, 246 (84.5%) find it very important to have a stable partnership, 234 (80.4%) to have a partner to share responsibility with, 188 students (64.6%) find it important to have independent work before becoming a parent. 5th and 6th year students showed better knowledge of menstrual phase when is most likely to get pregnant (N = 95, 92.2%) (p=0.042), the couple should seek specialist help after 12 months regularly sexual intercourse without contraception during pregnancy in women less than 35 years of age (N = 79, 76.7%) (p =0.000); and factors affecting fertility such as oral contraception, gonorrhea or chlamydial infection, obesity. Conclusion: It is statistically more important for women to have children than for men. Similarly, women are more likely to think that by becoming a parent they will give and receive more love, create new interests in life and get a different view of what is important. Students have relatively good knowledge of lifestyle factors that negatively affect female fertility such as smoking, underweight, gonorrhea or chlamydia infection, obesity

Womenʼs perspectives on the quality of maternal and newborn care in childbirth during the COVID-19 pandemic in Latvia : Results from the IMAgiNE EURO study on 40 WHO standards-based quality measures

Objective: To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. Methods: Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards-based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. Results: 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001). Conclusion: This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required. ClinicalTrials.gov Identifier:NCT04847336